Provider Demographics
NPI:1205858289
Name:PEASHKA, LYNN-MARIE MORGAN (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:LYNN-MARIE
Middle Name:MORGAN
Last Name:PEASHKA
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-2355
Mailing Address - Country:US
Mailing Address - Phone:208-799-6500
Mailing Address - Fax:208-799-6504
Practice Address - Street 1:428 6TH AVE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-2355
Practice Address - Country:US
Practice Address - Phone:208-799-6500
Practice Address - Fax:208-799-6504
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP3000-7028363LP0808X
IDNP-780363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9650722Medicaid
WA9650722Medicaid
Q50362Medicare UPIN